Your baby is technically considered a newborn for the first two months of life outside the womb but here we are going to focus on what to expect with your baby in the first 24-48 hours after birth. Within these first two days, your newborn will be adjusting to their new environment and will experience quite a few changes. It can seem overwhelming at first but with the support of birth or postpartum doulas, these changes will be easier to navigate. 

Newborn Appearance

Skin Coloring

Regardless of the baby’s ethnicity, newborns are born with a dark red to purple skin coloring. Once the baby is born and starts to breathe air, their skin color turns red. This is due to the baby’s circulatory system adjusting to its new environment. The redness will fade within the first day or two and their normal coloring will develop. Your baby may have other marks or areas of discoloration on their body, such as birthmarks or stork bites, that may fade over time. The baby’s hands and feet may have a bluish color for a few days as their circulatory system develops further. Although various skin color changes are normal within the first 48 hours, any blue coloring of other parts of the body is not normal and should be addressed with your care provider. 

Some babies are born with jaundice and will appear yellow in color in their skin and the whites of their eyes. Jaundice occurs in newborns when their liver isn’t mature enough to get rid of the bilirubin (a yellow pigment of red blood cells) in their bloodstream. Within the first few days following birth, it is important to feed your baby as much as possible because the excess bilirubin is eliminated with bowel movements. The more bowel movements the baby has, the quicker jaundice will resolve. Follow up with your care provider if you have any questions or concerns. 

Head Shape

If you give birth to your baby vaginally, your baby may come out with an elongated or cone-shaped head. Don’t freak out, it’s totally normal! Due to the incredible pressure put on your baby’s head as they squeeze through the birth canal, your baby’s skull bones will move and overlap therefore changing the shape of their skull. The longer they are in the birth canal, the more exaggerated their head shape will be. Their head shape should return to normal within the first 24-48 hours.  If you deliver your baby via C-section, the chances of your baby having a cone-shaped head decreases because the baby doesn’t much much time, if any, in the birth canal. 

Vernix Caseosa

Vernix caseosa is a white, creamy, naturally occurring substance that covers your baby’s skin during the third trimester of pregnancy. The purpose of the vernix coating remaining on the baby after birth is thought to be for immunity, water retention, temperature regulation, and protecting the delicate skin as the baby transitions to life outside the womb. Some babies are born with a thicker vernix coating while others are born without the appearance of vernix. Babies born closer to their due date or past their due date typically have less vernix as it reduces the closer baby gets to their due date. If your baby is born with a coating of vernix, it’s actually beneficial to leave it on their skin so they can absorb all the incredible properties! Allow it to absorb completely into their skin before giving your baby their first bath.

Feeding

Newborn babies will be ready to eat immediately after birth. They have a natural instinct to root around for a nipple. If you choose to breastfeed, your baby will latch and start feeding immediately after being born. Understand that while breastfeeding is a natural body process, it is a learned skill between mother and baby. Your care provider, nurse, doula, or lactation consultant will be able to help you and your baby have a successful breastfeeding journey. 

Your baby will be eating every 1-3 hours night and day those first few days whether they are breastfed or bottle fed. It can seem like they are eating constantly but keep in mind, their stomachs are the size of a marble and they can’t take in much milk in one feeding. Newborns will exhibit hunger cues that will help you determine when they are hungry and ready for another feed. The common signs of hunger are smacking lips, sticking out tongue, or rooting/searching for a breast. 

Sleeping

Within the first 48 hours after birth, you can expect your baby to sleep up to 18 hours a day! This will be broken up into 2-4 hour chunks as their hunger will wake them up every couple of hours. Although it will seem like your baby is always sleeping, they will have some alert, awake time, too! In the first 48 hours, it is normal for a newborn to be awake for 30-90 minutes at a time. Your baby will be exhausted from the birth process and will need a lot of rest, just like mom! You may hear the common phrase, “sleep when the baby sleeps” which is not always realistic but during the first 48 hours, definitely soak up all those newborn cuddles and try to focus on resting while your baby is sleeping.

Diapering

Your baby will not need many diaper changes during those first two days of life outside the womb. The day your baby is born, you can expect to see only one to two wet diapers and one to two poopy diapers. On the second day, you can expect to see two wet diapers and two poopy diapers. As they begin to eat more and more, they will begin producing more soiled diapers.

Your baby’s first bowel movement will consist of meconium, a thick, black, sticky, tar-like substance. It can be difficult to clean so try putting coconut oil on their skin to help make clean-up easier. As your baby begins feeding, their bowel movements will transition to more of a yellow color. 

Tests and Procedures

Immediately after delivery, parents will most likely have a “golden hour,” assuming the mom and baby are both stable. During this hour, you and your baby will have uninterrupted skin-to-skin time, the opportunity to feed your baby for the first time, and overall help your baby transition to the new environment. After the first hour is when your care team will start offering various tests and procedures. If you created a birth plan, your care team will follow your carefully thought-out instructions. 

Here are a few things that are conducted within 24-48 hours after birth unless you state otherwise: APGAR test, measurements and footprints, hearing test, newborn vaccines, antibiotic eye ointment, newborn metabolic screening, and circumcision. An APGAR test consists of testing your baby’s heart rate, breathing, activity and muscle tone, reflexes, and skin color. This test can take place while your baby rests peacefully on your chest as it is typically done 1 minute after birth and again 5 minutes after birth. Talk to your doctor, midwife, or birth doula if you have any questions about these tests and procedures. It is important to educate yourself and make informed decisions for your baby! These tests and procedures can also vary depending on where you give birth. Once you’ve decided where you plan to give birth, you can ask your care provider about their specific newborn procedures following their birth. 

Bringing a baby into the world is an incredible experience. You have a front-row seat to watching this little person discover the world for the first time! You helped them grow and change for nine months in your womb, and now you get to watch them grow and change on the outside! These first 24-48 hours will be exhausting and overwhelming but so beautiful. Make sure you pause and take it all in!